Rates of Nodal Upstaging following Systematic Endobronchial Ultrasound Lymph Node Staging in Non-Metastatic Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis
Abstract
INTRODUCTION: Accurate hilar and mediastinal staging is critical for prognosis and treatment selection in non-metastatic non-small cell lung cancer (NSCLC). While current guidelines recommend systematic mediastinal lymph node staging by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for early-stage disease, its utility in wider populations is increasingly recognized. We aimed to determine the rate of nodal upstaging following systematic endoscopic mediastinal staging in non-metastatic NSCLC. METHODS: MEDLINE, Embase, and Cochrane databases were searched from inception to February 2025. We included prospective and retrospective studies of adults with curative-intent NSCLC undergoing systematic EBUS-TBNA staging that reported per-patient nodal upstaging. Two reviewers independently extracted data. A random-effects meta-analysis assessed the pooled proportion of PET-occult lymph node metastases. Upstaging rates were quantified across clinical N stages. Subgroup analyses and meta-regression assessed methodological variables (PROSPERO: CRD42024547873). RESULTS: Twenty-six studies comprising 5,161 participants were included. The pooled rate of PET-occult nodal metastases was 8.6% (95% CI: 6.7-11.0%), corresponding to a number needed to test of 12. Nodal upstaging rates varied by clinical stage: 7.2% for cN0, 10.6% for cN1, 5.0% for cN2, and 0.3% for cN3. Statistical heterogeneity was substantial (I2 = 82.0%); however, subgroup analyses and…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 5,161 participants or records.
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